Removing Barriers: Creating better access to health services for people living with HIV,HCV and HBV Brent Allan Senior Coordinator Australasian Society for HIV Viral Hepatitis and Sexual Health Medicine (ASHM)

Overview of the Project Aim to reduce structural barriers, stigma and discrimination which impede access to the health service of people living with HBV, HCV or HIV, and people at risk of these conditions Hepatitis B barriers similar to culturally and linguistically diverse and indigenous populations Hepatitis C barriers associated with injection drug use HIV barriers vary by location strong in non-HIV or gay community settings self imposed/relate to perception as much as actual

Six key stigma-reduction principles and approaches 1. Education & information-based approaches 2. Skill building 3. Counselling approaches 4. Social contact-interaction 5. Structural approaches 6. Biomedical approaches 1. Education & information-based approaches: Evidence-based, written information in a brochure and other media. These programs should engage in myth-busting through the provision of reliable evidence. Such programs should emphasise and demonstrate recovery from illness as a key part of its messaging 2. Skill building: Exercises that entail tangible learning strategies to reduce negative attitudes. Such programs should focus on behaviour change by teaching skills that help health care professionals know what to say and what to do when engaging people with a stigmatised illness 3. Counselling approaches: Such as attending support groups (particularly to address internalised stigma) 4. Social contact-interaction: Including testimonials and interaction between people from the general population and from stigmatised groups; personal testimonies from trained speakers with lived experience of stigmatised illness; employ multiple forms of social contact (e.g., several first-voice speakers, a live speaker presentation and a video presentation) 5. Structural approaches: Such as changing discriminatory workplace policies and laws, and increasing health professionals’ and health students’ structural competency (see Metzl & Hansen, 2014) 6. Biomedical approaches: In the context of HIV infection, such as antiretroviral treatment and PrEP to reduce new HIV infections

Project Phases Planning Gathering research and community feedback Baseline data collection in collaborating services Trialling and Evaluating interventions Implementation Developing up interventions to be rolled out across health system Supported by a range of establishment organisations

Health Services Data Sites exist in 6 of the 9 states Do service users feel discriminated against or stigmatised? Are patients staged appropriately? Are patients key demographics entered? Do staff have training in non- discriminatory practices?

Implementation Partners 9 collaborating health services 8 implementation partners 6 community partners 2 research and communication partners

Overview of the interventions Intervention 1: Improved experience of patients in the waiting room. Intervention 2: Stigma and discrimination competency for practice nurses. Intervention 3: Stigma and discrimination are part of health service management educational and professional offerings. Intervention 4: Stigma and discrimination is included in ethics sessions in undergraduate and CME programs. Intervention 5: Improved completeness of data collected in health care services, to facilitate improved care and develop an evidence base. Initiative 6: Development of a discussion paper on the cost of opiate substitution therapy (OST) Initiative 7: Develop an awareness resource on injection drug use Intervention 8: Advocate for a review of Practice Standards which prohibit people with a BBV from practicing Intervention 9: increase the workplace safety and capacity of HCW living with HIV,HVC or HBV to challenge stigma and discrimination Intervention 1: Improved experience of patients in the waiting room, approaching services, and optimising the front of house role in patient management and service delivery, through training Intervention 2: Stigma and discrimination is a dimension of competency in the education and career path for practice nurses. Training is made available to demonstrate competency at all levels in this domain Intervention 3: Issues of stigma and discrimination and structural barriers are recognised as important by the ACHSM and flow through to their various programs, educational and professional offerings. Intervention 4: The importance of addressing stigma and discrimination included in Ethics sessions (undergraduate and RACGP/ACRRM) and CME programs. Intervention 5: Improved completeness of data collected in health care services, to facilitate improved care, screening and access to opportunities for priority populations and increased participation in surveillance, monitoring, research and development of evidence base. Initiative 6: The cost of OST in the community should not inhibit its use - Development of a discussion paper Initiative 7: Redevelopment of AIVL/NUUA resource on injection drug use (this is currently a year 2 activity though some discussion have commenced) Intervention 8: RACGP Practice Standards – Submission to review

What steps have been taken? Comprehensive literature review of the stigma and discrimination in health care settings Updated RACGP practice standards to include stigma and discrimination Community submissions on systemic barriers in accessing health services. (n=9) Policy and practice documents relating to other workforce domains including: Geographic issues (eg. Malaysia) Cost factors (eg. OST) Specialist issues (eg. HIV nurse specialists) Updating standards and accreditation Master Health Service Management competency framework Standards for Assessment and Accreditation of Primary Medical Programs by the Australian Medical Council

What activities are currently underway? Online training packages which address stigma and discrimination Front of house reception staff nurses Medical education students training modules utilizing people living with HIV,HCV and HBV My Story - awareness videos on what it means to live with HIV,HCV and HBV and what barriers people face in health care settings Responsiveness video which aims to enable HCW to appreciate and intervene with PWID

ASHM Priorities and Sustainability All outputs are to be electronic/on-line Establishment of a service directory ASHM commissions content development with implementing agencies Policy production Position ASHM as a clearinghouse on stigma and discrimination resources for the health services sector Share footprint nationally and internationally www.removingbarriers.ashm.org.au